In our days CHD is the leading cause of death in the western countries. Atherosclerosis (thickened artery walls) or the narrowing of the coronary arteries, caused by an inflammation or a spasm of an artery, may impair or even fully block the blood flow, leading to angina pectoris, heart attack, or sudden death. Most heart attacks may occur with less than 50 % blockage of an artery.

The progression of atherosclerosis underlies for many years before CHD symptoms arise. The symptoms are usually, discomfort in chest region, pain may radiate to the left arm, shoulders, back, throat, even teeth. In angina pectoris the symptoms arise by exertion, and subside with rest. In heart attack, the pain may be severe, last longer, and occurs without exertion.

The medication treatment combined with nutritional modifications focuses on lowering LDL cholesterol and other blood lipids level. In order to maintain low blood lipids level and reduce the risk of CHD, patients must be convinced to adhere in a therapeutic lifestyle changes program. The main features of this program include a LDL-lowering diet, weight reduction, and moderate physical activity. The dietitian must approach the patient carefully and individualize the step by step procedure. If the recommendations are eventually followed, the progress would be substantial in only 4-6 week period.

Dietary and Lifestyle Modifications;

Low Saturated Fat Diet (less than 7% of total energy consumption. Saturated fats are the dietary lipids with the strongest effect on blood cholesterol levels. Replace them with monounsaturated and polyunsaturated fats. Replacing butter with vegetable oil, choosing lean meat and fish, fat-free or low fat dairy products, and avoiding certain types of baker products, are some of the measures to reduce LDL levels.
Replacing saturated fats with carbohydrates may also contribute on lowering LDL cholesterol. Choosing grains, legumes, fruits, vegetables and nuts will assist our effort. In hypertriglyceridemia the carbohydrate consumption should be monitored.
Avoid Trans-Fatty Acids. Those fatty-acids may raise LDL cholesterol levels. Also alter blood vessel function, promote inflammation, reduce LDL size and increase the risk for CHD.

Dietary Cholesterol Levels. The recommendation must focus on lowering the daily cholesterol consumption less than 200mg per day.
Soluble Fibers. A diet rich in soluble fibers may reduce LDL levels, by inhibiting cholesterol and bile absorption in the small intestine and reduces cholesterol synthesis in the liver.

Low Sodium and Moderate Potassium Intakes. A diet abundant in fruits and vegetables, whole grains, nuts, low-fat dairy products may help in lowering blood pressure, and eventually reduce the risk of CHD.

Omega-3 Fatty Acids. Fish consumption once or twice a week, provides adequate amounts of EPA and DHA (omega-3 fatty acids). EPA & DHA are very affective on suppressing inflammation, reducing blood clotting and lowering triglyceride levels.

Alcohol. Only low amounts of alcoholic beverages are allowed and may be even beneficial. High consumption is associated with high mortality rates.
Plant Sterols and Stanols. These plant compounds works by interfering with cholesterol absorption. Many clinical studies show that 2 grams/ day may reduce LDL levels by up to 15%, without lowering HDL levels.

Physical Activity. Aerobic activities can lower triglyceride levels, raise HDL levels, lower blood pressure, promote weight loss, improve insulin resistance and strengthen heart muscle. 60 minutes/ day of aerobic activities, are recommended for adults, in order to maintain healthy.

Smoking Cessation. Compounds in smoke are causing inflammation, reducing HDL levels, damage vessel cells, raise heart rate and blood pressure, promote blood clotting and reduces the oxygen carrying capacity of the blood.

Weight Loss. Obesity is an independent risk factor for CHD. Promotes inflammation, blood clotting and raise the risk of atherosclerosis. Obesity increases the heart workload by increasing the blood volume. Also leads to insulin resistance, hypertension, hypertriglyceridemia, low HDL levels, and reduction of LDL size.